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      Improving gender equity in critical care medicine: a protocol to establish priorities and strategies for implementation

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          Abstract

          Introduction

          While the number of women entering medical school now equals or surpasses the number of men, gender equity in medicine has not been achieved. Women continue to be under-represented in leadership roles (eg, deans, medical chairs) and senior faculty positions. In addition, women do not enter medical specialties as often as men, which can have important implications for work environment, reimbursement and the delivery of patient care. Compared with other medical specialties (eg, anaesthesiology, dermatology, etc), critical care medicine is a medical specialty with some of the lowest representation of women. While strategies to improve gender equity in critical care medicine exist in the published literature, efforts to comprehensively synthesise, prioritise and implement solutions have been limited.

          The objective of this programme of work is to establish priorities for the development and implementation of key strategies to improve the outcomes, well-being and experiences of women in critical care in Canada.

          Methods and analysis

          Three phases encompass this programme of work. In phase I, we will catalogue published strategies focused on improving gender inequity across medical specialties through a scoping review. In phase II, we will conduct a modified Delphi consensus process with decision-makers, physicians and researchers to identify key strategies (identified in phase I and proposed by participants in phase II) for improving gender inequity in the specialty of critical care medicine. Finally, in phase III, we will conduct a 1-day stakeholder meeting that engages participants from phase II to build capacity for the development and implementation of top ranked strategies. Data analyses from this programme of work will be both quantitative and qualitative.

          Ethics and dissemination

          The proposed programme of work is a foundational step towards establishing targeted strategies to improve gender inequity in the medical specialty of critical care medicine. Strategies will be prioritised by stakeholders, mapped to preidentified drivers of gender equity in the specialty and be scalable to institutional needs. A final report of our results including the list of top prioritised strategies and implementation objectives will be disseminated to panel participants, critical care leadership teams and major critical care societies who are partners in this work, around the country to facilitate uptake at the local level.

          The University of Calgary Conjoint Health Research Ethics Board has approved this study (REB16-0890).

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          Most cited references17

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          Are gender gaps due to evaluations of the applicant or the science? A natural experiment at a national funding agency

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            Relation of family responsibilities and gender to the productivity and career satisfaction of medical faculty.

            Studies have found that female faculty publish less, have slower career progress, and generally have a more difficult time in academic careers than male faculty. The relation of family (dependent) responsibilities to gender and academic productivity is unclear. To describe dependent responsibilities by gender and to identify their relation to the aspirations, goals, rate of progress, academic productivity, and career satisfaction of male and female medical school faculty. 177-item survey questionnaire. 24 randomly selected medical schools in the contiguous United States. 1979 respondents from a probability sample of full-time academic medical school faculty. The main end point for measuring academic productivity was the total number of publications in refereed journals. Perceived career progress and career satisfaction were assessed by using Likert scales. For both male and female faculty, more than 90% of time devoted to family responsibilities was spent on child care. Among faculty with children, women had greater obstacles to academic careers and less institutional support, including research funding from their institutions (46% compared with 57%; P < 0.001) and secretarial support (0.68 full-time equivalents compared with 0.83 full-time equivalents; P = 0.003), than men. Compared with men with children, women with children had fewer publications (18.3 compared with 29.3; P < 0.001), slower self-perceived career progress (2.6 compared with 3.1; P < 0.001), and lower career satisfaction (5.9 compared with 6.6; P < 0.001). However, no significant differences between the sexes were seen for faculty without children. Compared with female faculty without children and compared with men, female faculty with children face major obstacles in academic careers. Some of these obstacles can be easily modified (for example, by eliminating after-hours meetings and creating part-time career tracks). Medical schools should address these obstacles and provide support for faculty with children.
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              The impact of gender and parenthood on physicians' careers - professional and personal situation seven years after graduation

              Background The profile of the medical profession is changing in regard to feminization, attitudes towards the profession, and the lifestyle aspirations of young physicians. The issues addressed in this study are the careers of female and male physicians seven years after graduation and the impact of parenthood on career development. Methods Data reported originates from the fifth assessment (T5) of the prospective SwissMedCareer Study, beginning in 2001 (T1). At T5 in 2009, 579 residents (81.4% of the initial sample at T1) participated in the questionnaire survey. They were asked about occupational factors, career-related factors including specialty choice and workplace, work-life balance and life satisfaction. The impact of gender and parenthood on the continuous variables was investigated by means of multivariate and univariate analyses of variance; categorical variables were analyzed using Chi-square tests. Results Female physicians, especially those with children, have lower rates of employment and show lower values in terms of career success and career support experiences than male physicians. In addition, parenthood has a negative impact on these career factors. In terms of work-life balance aspired to, female doctors are less career-oriented and are more inclined to consider part-time work or to continue their professional career following a break to bring up a family. Parenthood means less career-orientation and more part-time orientation. As regards life satisfaction, females show higher levels of satisfaction overall, especially where friends, leisure activities, and income are concerned. Compared to their male colleagues, female physicians are less advanced in their specialty qualification, are less prone to choosing prestigious surgical fields, have a mentor less often, more often work at small hospitals or in private practice, aspire less often to senior hospital or academic positions and consider part-time work more often. Any negative impact on career path and advancement is exacerbated by parenthood, especially as far as women are concerned. Conclusion The results of the present study reflect socially-rooted gender role stereotypes. Taking into account the feminization of medicine, special attention needs to be paid to female physicians, especially those with children. At an early stage of their career, they should be advised to be more proactive in seeking mentoring and career-planning opportunities. If gender equity in terms of career chances is to be achieved, special career-support measures will have to be provided, such as mentoring programs, role models, flexitime and flexible career structures.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2020
                11 June 2020
                : 10
                : 6
                : e037090
                Affiliations
                [1 ]departmentSchool of Health Administration , Dalhousie University , Halifax, Nova Scotia, Canada
                [2 ]departmentDepartment of Critical Care Medicine , University of Calgary , Calgary, Alberta, Canada
                [3 ]departmentDepartment of Medicine , University of Calgary , Calgary, Alberta, Canada
                [4 ]departmentDivision of Critical Care Medicine , London Health Sciences Centre , London, Ontario, Canada
                [5 ]departmentDepartment of Medicine , Western University Schulich School of Medicine and Dentistry , London, Ontario, Canada
                [6 ]departmentCritical Care , St. Michael’s Hospital , Toronto, Ontario, Canada
                [7 ]departmentInterdepartmental Division of Critical Care Medicine, Department of Medicine , University of Toronto , Toronto, Ontario, Canada
                [8 ]Sunnybrook Research Institute , Toronto, Ontario, Canada
                [9 ]departmentDepartment of Medicine, Division of Critical Care Medicine , McMaster University , Hamilton, Ontario, Canada
                [10 ]departmentDepartment of Medicine , Western University , London, Ontario, Canada
                [11 ]departmentLi Ka Shing Knowledge Institute , St. Michael’s Hospital , Toronto, Ontario, Canada
                [12 ]departmentDepartments of Critical Care Medicine, Department of Psychiatry & Hotchkiss Brain Institute and Department of Community Health Sciences , University of Calgary Cumming School of Medicine , Calgary, Alberta, Canada
                [13 ]O'Brien Institute for Public Health , Calgary, Alberta, Canada
                [14 ]departmentDepartment of Critical Care Medicine, Department of Community Health Sciences , University of Calgary , Calgary, Alberta, Canada
                Author notes
                [Correspondence to ] Dr Jeanna Parsons Leigh; j.parsonsleigh@ 123456dal.ca

                KF and HTS are joint senior authors.

                Author information
                http://orcid.org/0000-0002-8408-674X
                http://orcid.org/0000-0001-9912-3606
                http://orcid.org/0000-0002-6617-9790
                http://orcid.org/0000-0002-7299-6594
                Article
                bmjopen-2020-037090
                10.1136/bmjopen-2020-037090
                7295422
                32532779
                dbe6fa26-3180-45e8-b5fd-44e572cba255
                © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 20 January 2020
                : 09 April 2020
                : 19 May 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000024, Canadian Institutes of Health Research;
                Categories
                Intensive Care
                1506
                1707
                Protocol
                Custom metadata
                unlocked

                Medicine
                intensive & critical care,general medicine (see internal medicine),health services administration & management,protocols & guidelines

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